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Perspective
Statins: Is It Really Time to Reassess Benefits and Risks?
No drug provides health benefits without some degree of risk, and risk–benefit assessments require ongoing review as new data become available. This is certainly the case for the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors — statins — and the risk of new-onset…
- May 10, 2012
- Goldfine A.B.
- N Engl J Med 2012; 366:1752-1755
- Free Full Text
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The Food and Drug Administration has added information to statin labels regarding an effect on diabetes, noting reported increases in glycated hemoglobin and fasting serum glucose levels but adding that it believes that the cardiovascular benefits outweigh the risks.
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Original Article
A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes
Increases in childhood obesity have been accompanied by an increased incidence of type 2 diabetes in youth. Because the risk of microvascular and macrovascular complications in adults increases with both the duration of diabetes and lack of glycemic control,, it is imperative to achieve and sustain…
- April 29, 2012
- TODAY Study Group
- 10.1056/NEJMoa1109333
- Free Full Text
Increases in childhood obesity have been accompanied by an increased incidence of type 2 diabetes in youth.¹,² Because the risk of microvascular and macrovascular complications in adults increases with both the duration of diabetes and lack of glycemic ...
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Editorial
TODAY — A Stark Glimpse of Tomorrow
Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined with conflicts between individual freedom and…
- April 29, 2012
- Allen D.B.
- 10.1056/NEJMe1204710
- Free Full Text
Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined ...
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Editorial
Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes?
Type 2 diabetes is one of the fastest growing epidemics in human history and is closely associated with obesity. Furthermore, the disease has multiple manifestations and is associated with progressive beta-cell failure. Although lifestyle measures, including weight loss and physical activity,…
- April 26, 2012
- Zimmet P. and Alberti K.G.M.M.
- N Engl J Med 2012; 366:1635-1636
Type 2 diabetes is one of the fastest growing epidemics in human history and is closely associated with obesity.¹ Furthermore, the disease has multiple manifestations and is associated with progressive beta-cell failure.² Although lifestyle measures, ...
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Clinical Therapeutics
Insulin-Pump Therapy for Type 1 Diabetes Mellitus
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- April 26, 2012
- Pickup J.C.
- N Engl J Med 2012; 366:1616-1624
A 39-year-old man with type 1 diabetes mellitus is referred for consideration of insulin-pump therapy because of poor glycemic control and episodes of severe hypoglycemia. Insulin-pump therapy can improve blood glucose control but requires a willing and motivated patient.
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Original Article
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
The growing incidence of obesity and type 2 diabetes mellitus globally is widely recognized as one of the most challenging contemporary threats to public health. Uncontrolled diabetes leads to macrovascular and microvascular complications, including myocardial infarction, stroke, blindness,…
- April 26, 2012
- Schauer P.R., Kashyap S.R., Wolski K., et al.
- N Engl J Med 2012; 366:1567-1576
- CME
In this randomized, controlled study of obese patients with type 2 diabetes, those who received medical therapy plus bariatric surgery had significantly better glycemic control at 12 months than did those who received medical therapy alone.
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Original Article
Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes
The prevalence of type 2 diabetes mellitus is rapidly increasing worldwide, in parallel with the current obesity epidemic. In 2010, the global prevalence of type 2 diabetes was estimated at 8.3% of the adult population, a proportion that is projected to increase to 9.9% by 2030. As many as 23% of…
- April 26, 2012
- Mingrone G., Panunzi S., De Gaetano A., et al.
- N Engl J Med 2012; 366:1577-1585
In this study involving severely obese patients with type 2 diabetes, Roux-en-Y gastric bypass and biliopancreatic diversion achieved better glucose control than conventional medical therapy as assessed at 2 years.
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Clinical Implications of Basic Research
Metabolic Health and Nuclear-Receptor Sensitivity
As the incidence of type 2 diabetes increases, new treatments are clearly needed. Many hormones and drugs that control metabolic pathways function as agonists or antagonists of nuclear receptors, which constitute a family of ligand-activated transcription factors. Included in this family, among…
- April 5, 2012
- Hollenberg A.N.
- N Engl J Med 2012; 366:1345-1347
Thiazolidinediones activate the nuclear receptor PPAR-γ, which brings about increased glucose tolerance and glucose sensitivity. Endogenous ligand can achieve the same effect under certain conditions, suggesting a different approach to activating the same pathway.
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Clinical Practice
Glycemic Management of Type 2 Diabetes Mellitus
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 39-year-old…
- April 5, 2012
- Ismail-Beigi F.
- N Engl J Med 2012; 366:1319-1327
- CME
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This article provides a framework for establishing glycemic targets for patients with type 2 diabetes, taking into account both psychosocial and clinical factors, and discusses strategies to achieve the targets. First-line treatments and additional therapies are discussed.
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Review Article
Mechanisms of Disease: Diabetic Retinopathy
Until recently, the treatment for diabetic retinopathy relied almost exclusively on managing the metabolic dysregulation of diabetes mellitus until the severity of vascular lesions warranted laser surgery. Intensive metabolic control remains a highly effective means of controlling retinopathy and…
- March 29, 2012
- Antonetti D.A., Klein R., Gardner T.W.
- N Engl J Med 2012; 366:1227-1239
- CME
The incidence of diabetes is increasing, but that of diabetic retinopathy is falling, probably owing to better management of glucose levels, lipid abnormalities, and hypertension. Clinical trials of VEGF and PPAR-α inhibitors are improving vision and providing insights into pathogenesis.
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Original Article
Lifestyle Change and Mobility in Obese Adults with Type 2 Diabetes
The growing prevalence of type 2 diabetes mellitus is an ominous health threat in the United States, and globally. Surveillance data from the Centers for Disease Control and Prevention cite type 2 diabetes as largely a disease of aging, and its prevalence may escalate as the population gets older.…
- March 29, 2012
- Rejeski W.J., Ip E.H., Bertoni A.G., et al.
- N Engl J Med 2012; 366:1209-1217
This trial investigated whether an intensive lifestyle intervention to produce weight loss and increased fitness would slow loss of mobility among obese patients with type 2 diabetes. Both weight loss and improved fitness were associated with a decline in the rate of mobility loss.
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Images in Clinical Medicine
Eruptive Xanthoma
Figure 1.
- March 1, 2012
- Kala J. and Mostow E.N.
- N Engl J Med 2012; 366:835
- Free Full Text
A 30-year-old woman with diabetes who had poor glucose control, hypertension, and hyperlipidemia was referred for evaluation of a rash of 1 month's duration. She reported no fevers, chills, or joint pain, nor had she taken glucocorticoids or had contact with anyone with similar symptoms.
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Images in Clinical Medicine
Insulin-Induced Lipohypertrophy
Figure 1.
- February 2, 2012
- Landau S.
- N Engl J Med 2012; 366:e9
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A 55-year-old man with a 31-year history of type 1 diabetes mellitus presented for a routine clinical evaluation, his first in two decades. His insulin regimen consisted of a combination of neutral protamine Hagedorn (NPH) and rapid-acting insulin. In the ...
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Original Article
GAD65 Antigen Therapy in Recently Diagnosed Type 1 Diabetes Mellitus
The clinical onset of type 1 diabetes is manifested by the effects of inadequate insulin secretion due to the immunologic destruction of pancreatic-islet beta cells. Despite replacement therapy with exogenous insulin, type 1 diabetes is associated with substantial morbidity and mortality. Even…
- February 2, 2012
- Ludvigsson J., Krisky D., Casas R., et al.
- N Engl J Med 2012; 366:433-442
This trial assessed alum-formulated glutamic acid decarboxylase, the 65-kD isoform (GAD65), a major autoantigen in type 1 diabetes. In patients with recent-onset disease; the compound did not significantly alter the loss of C peptide or improve clinical outcomes.
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Clinical Implications of Basic Research
Diabetic Stem-Cell “Mobilopathy”
Hematopoietic stem-cell (HSC) transplantation remains the primary curative treatment for patients with a variety of hematologic cancers. Transplantation of either autologous or allogeneic stem cells requires the acquisition of sufficient numbers of HSCs to ensure rapid and consistent trilineage…
- December 29, 2011
- DiPersio J.F.
- N Engl J Med 2011; 365:2536-2538
Obtaining hematopoietic stem cells (HSCs) for transplantation depends on effective egress of HSCs from bone marrow into the peripheral circulation on induction. This process is impaired in a mouse model of diabetes and in patients undergoing autologous transplantation.
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Original Article
Intensive Diabetes Therapy and Glomerular Filtration Rate in Type 1 Diabetes
An impaired glomerular filtration rate (GFR) is the final common pathway of diabetic kidney disease. Once the GFR is impaired, cardiovascular disease events and progression to end-stage renal disease occur at unacceptably high rates, even with proven medical management.– This underscores the need…
- December 22, 2011
- The DCCT/EDIC Research Group
- N Engl J Med 2011; 365:2366-2376
- CME
Persons with type 1 diabetes are at high risk for kidney disease. In this study, intensive diabetes therapy administered early in the course of type 1 diabetes reduced the long-term risk of an impaired glomerular filtration rate.
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Special Article
Emergency Hospitalizations for Adverse Drug Events in Older Americans
Decreasing the number of preventable rehospitalizations by 20% by the end of 2013 is a goal of the $1 billion federal initiative Partnership for Patients, and the pursuit of this goal represents an opportunity to reduce harm to patients and reduce health care costs. Adverse drug events are a direct…
- November 24, 2011
- Budnitz D.S., Lovegrove M.C., Shehab N., Richards C.L.
- N Engl J Med 2011; 365:2002-2012
- Free Full Text
This national study estimated that nearly 100,000 elderly patients were hospitalized for adverse drug events annually from 2007 through 2009. Most resulted from use of common medications such as warfarin and insulin, and only 1% from medications designated as high-risk.
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Clinical Implications of Basic Research
Beta-Cell Failure, Stress, and Type 2 Diabetes
Type 2 diabetes mellitus is caused by a combination of genetic and environmental factors that result in decreased insulin function at sites of insulin action and a reduced ability of pancreatic beta cells to elevate insulin secretion in response to increased blood glucose levels. The variant genes…
- November 17, 2011
- Kaufman R.J.
- N Engl J Med 2011; 365:1931-1933
CDKAL1, a gene implicated in susceptibility to type 2 diabetes, has been found to mediate a fundamental event in protein translation that affects proinsulin processing.
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Original Article
Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors
During the past three decades, the prevalences of overweight and obesity in the pediatric population have increased substantially. Childhood obesity is a predictor of an increased rate of death, owing primarily to an increased risk of cardiovascular disease.– Forecasts suggest that the "obesity…
- November 17, 2011
- Juonala M., Magnussen C.G., Berenson G.S., et al.
- N Engl J Med 2011; 365:1876-1885
- Free Full Text
- CME
In four prospective cohort studies, obese adults who were overweight or obese in childhood had increased rates of cardiovascular risk factors. Those who were overweight or obese as children but not as adults had risks similar to the risks among those who were never obese.
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Editorial
Childhood Obesity and Coronary Heart Disease
Obesity is the most common nutritional problem among children in both developed and underdeveloped countries. Despite efforts over the past decade to prevent and control obesity, data from the 2003–2006 National Health and Nutrition Examination Surveys (NHANES) show that 16.3% of children and…
- November 17, 2011
- Rocchini A.P.
- N Engl J Med 2011; 365:1927-1929
Obesity is the most common nutritional problem among children in both developed and underdeveloped countries. Despite efforts over the past decade to prevent and control obesity, data from the 2003–2006 National Health and Nutrition Examination Surveys (...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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